Emotional Intelligence: The Missing Link in Diabetes Treatment

It is generally acknowledged that non-adherence rates for chronic disease regimens and lifestyle changes average at 50% in developed countries worldwide, with even lower rates in developing nations. More than 34.2 million Americans are diagnosed with diabetes, and another 88 million with early-stage diabetes (sometimes referred to as pre-diabetes, though, without intervention, about 70% will become full-blown diabetes). In addition to this, people with diabetes are more likely to have harsher symptoms and added serious complications from COVID-19. With most intervention programs today being human-dependent and highly expensive, cost-effectiveness and patient engagement at scale are both key restrictions in solutions targeting diabetes management optimization and prevention. The best of the current solutions combined serve, at most, 10% of the population in need.

As a group, people with diabetes are especially prone to substantial regimen adherence challenges. Despite the evidence-based dimensions of good diabetes self-care, such as weight control, regular physical activity, blood glucose self-monitoring and medication management, many patients with diabetes continue to face hurdles. These challenges lead to increased morbidity and mortality, high healthcare costs, and great frustration among both patients and practitioners. The question most often voiced by diabetes care teams is, “How do I help activate or empower my patients to better manage their diabetes?”

Current protocols in managing diabetes patients

Diabetes is a primary example in which self-management, and moreover, the ability to maintain behavioral change and adherence over time, play a crucial role in care. To optimize their health, individuals with diabetes are often advised regarding their diet and exercise, receive frequent medical check-ups, as well as annual specialized examinations of their eyes and feet, and take multiple prescribed oral or injected medications every day. This is an overwhelming list, and we cannot ignore the huge responsibility that falls on these individuals. Until there is a cure for diabetes, all these behaviors usually need to be sustained for a lifetime, and the choice to adhere to these protocols ultimately lies with the patient themselves.

Managing diabetes is a complex task that feels endless and overwhelming, making it a seemingly impossible task for patients who are already feeling demotivated by their disease. In order to achieve success in treatment protocol adherence, patients and their healthcare providers need to be aligned. But with the millions of patients required to abide by specific health regimens on a daily basis, how can these organizations maintain continuous, valuable connections at scale?

The global health industry is investing billions in the development of drugs, digital therapeutics, devices, wearables and services to empower patients to manage their health, all competing for the invaluable relationship with customers to better serve them and improve their quality of life. But overcoming the global challenge of holistic intervention protocol non-adherence can only be achieved when patients, on their own, actually do what they need to do to comply with their health regimens.

Effective therapies require frequent, individualized interventions that extend beyond the hospital and clinic to reach patients in their day-to-day lives. A mismatch currently exists between what the health care system and human-dependent chronic disease prevention and management programs are equipped to provide, and the interventions necessary to effectively address the chronic disease epidemic burden. Improving clinical outcomes requires overcoming the “last mile problem” involving patient behavior, as even the most appropriate medical treatment will be effective only if the patient follows through with it.

Despite increasing advances in sophisticated medications and diabetes-related devices, we are left with the fundamental, enduring issue of human behavior. How do we help people effectively incorporate diabetes self-care into their lives and become proactive in implementing and maintaining goal-directed habits over the course of their disease? How do we help clinicians and healthcare organizations better support these efforts? A challenging disease to manage successfully, physicians know that if their patients adhered to their treatment recommendations, they could really improve their health and avoid diabetes-related complications.

Behavior: The heart of every diabetes intervention

Issues of adherence to treatment have been studied for years, but only recently have models derived from behavioral science been used to improve patient follow-through. Researchers have also begun exploring whether data-driven precision medicine can incorporate personalized behavioral “nudges” that improve patient ability and willingness to follow recommendations. This can be achieved by offering highly tailored prompts via a mobile app to address each patient’s specific life habits and motivational profile. Nowadays, the most convenient way to “nudge” someone to action is via their cellphone. Yet, most nudging solutions today are generic and don’t adapt to the user’s real-life needs, habits, schedule, priorities, motivations and more. Prompting a patient with a message like “You still need to reach your 10,000 steps today” is often ineffective, especially in the long run, where impersonal recommendations can actually create alert fatigue. Just as a particular treatment won’t work equally well for each patient, generic behavioral interventions will not trigger action by every patient.

This is where “precision engagement” comes in. Only recently applied to healthcare, it combines data science and behavioral science to customize the behavioral intervention most likely to motivate a patient to change a behavior and remain engaged, long-term, in their treatment protocol. Patients can finally be offered inspiring interventions that are tailored to their own personalities, goals, care journeys and engagement challenges. How can this be achieved? With the help of advanced artificial intelligence (AI) technologies and machine learning algorithms, we can deliver the right stimuli recommendations to the right patient, in the right tone, at the right time, and in the right way, to improve adherence to their given therapies.

Combining AI and EI to make the change

AI is a term we are all familiar with now, and it continues to add immense value to the digital health industry. While AI allows us to delve deeper into the patient experience, the one thing that is missing is the human touch. To truly perfect precision engagement, emotional intelligence (EI) is the key. Unlike AI, EI isn’t something we can see, or work with physically. EI refers to the personality and intellectual capacity of a person, which develops throughout their lifetime. More specifically, it is a person’s information processing capacity arising from their emotions, and their ability to guide action in situations that require activation of the cognitive system. Simply put, what emotion triggers a specific person to act? What will make Patient A take their medication this morning? What will make Patient B get in their daily exercise?

The answers to these questions lie in hyper-personalized recommendations, or the “nudges” we mentioned above, which are automatically adjusted according to the specific individual’s past behavior patterns and current real-world context. Using AI technology, various types of data can be sensed and collected from a patient’s smartphone and other connected devices, including raw data related to their activity, location, Wi-Fi connection, sleep patterns, weight, glucose levels, medications, nutrition, mood and more. Then, this raw data is processed and analyzed to understand the patient’s behaviors and habits. Using these combined forces, we can finally understand when, where and how to best interact with diabetes patients to effectively impact their behaviors and long-term health at scale.

Another added value is reinforcement learning, a subset domain within AI, which has the ability to address each individual with health recommendations in the tone of voice that has the highest probability of achieving adherence. Adapting tone of voice to each individual can result in the most effective, hyper-personalized experience.

The ultimate solution

The world is facing a major challenge when it comes to keeping people with diabetes motivated to stick with their health regimens, even when their life depends on it. It is of the utmost importance that we start normalizing tailored intervention methods that have proven efficacy – methods that don’t  frustrate patients more, but encourage them, motivate them, and support them in living a healthier life.

We have the technology available to us now to begin implementing personalized engagement tools into the management of diabetes patients. Rolling out these solutions will not only combat the global challenge of treatment non-adherence, but will also allow people managing their diabetes to truly see a difference in their health. This can be a reality with automated, customized plans for every diabetes patient based on their individual personas, continuously adapted according to their behavior and context. Physicians want to be there for their patients, but cannot be micro-managers of their behaviors. This is a key advantage to adopting digital solutions – supporting physicians in managing their patient loads and enabling patients to better follow their treatment plans for better health outcomes.

Dr. Yossi Bahagon is co-founder and active chairman of Sweetch.

Yoni Nevo is CEO of Sweetch.